Abstract
BackgroundMonovalent rotavirus vaccine, Rotarix (GlaxoSmithKline), was introduced in Kenya in July 2014 and is recommended to infants as oral doses at ages 6 and 10 weeks. A multisite study was established in 2 population-based surveillance sites to evaluate vaccine impact on the incidence of rotavirus-associated hospitalizations (RVHs).MethodsHospital-based surveillance was conducted from January 2010 to June 2017 for acute diarrhea hospitalizations among children aged <5 years in 2 health facilities in Kenya. A controlled interrupted time-series analysis was undertaken to compare RVH pre– and post–vaccine introduction using rotavirus-negative cases as a control series. The change in incidence post–vaccine introduction was estimated from a negative binomial model that adjusted for secular trend, seasonality, and multiple health worker industrial actions (strikes).ResultsBetween January 2010 and June 2017 there were 1513 and 1652 diarrhea hospitalizations in Kilifi and Siaya; among those tested for rotavirus, 28% (315/1142) and 23% (197/877) were positive, respectively. There was a 57% (95% confidence interval [CI], 8–80%) reduction in RVHs observed in the first year post–vaccine introduction in Kilifi and a 59% (95% CI, 20–79%) reduction in Siaya. In the second year, RVHs decreased further at both sites, 80% (95% CI, 46–93%) reduction in Kilifi and 82% reduction in Siaya (95% CI. 61–92%); this reduction was sustained at both sites into the third year.ConclusionsA substantial reduction in RVHs and all-cause diarrhea was observed in 2 demographic surveillance sites in Kenya within 3 years of vaccine introduction.
Highlights
Monovalent rotavirus vaccine, RotarixTM, was introduced in Kenya in July 2014, is recommended to infants as oral doses at ages 6 and 10 weeks
There was a 57% reduction in rotavirus-associated hospitalisations (RVH) observed in the first year post vaccine introduction in Kilifi and a 59% reduction in Siaya
RVH decreased further at both sites, 80% reduction in Kilifi and 82% reduction in Siaya, and this reduction was sustained at both sites into the third year
Summary
Monovalent rotavirus vaccine, RotarixTM, was introduced in Kenya in July 2014, is recommended to infants as oral doses at ages 6 and 10 weeks. In 2009, the World Health Organisation (WHO) recommended that all countries, especially those with high diarrhoea associated child mortality rates, implement rotavirus immunisation programmes[5]. Kenya adopted this recommendation in July 2014[6,7]. Two doses of live attenuated rotavirus vaccine (RotarixTM), in addition to oral polio, pneumococcal conjugate (PCV) and pentavalent vaccines, have been recommended to children in Kenya, targeted at 6 and 10 weeks of life, as part of the routine child immunisation programme[8,9]. We used demographic and hospital data from two populationbased surveillance sites in Kenya to estimate the impact of the programme on rotavirus hospitalizations in children
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